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ECG Review

ECG Review. James T. DeVries, MD 6 December 2004. 45 yo female 1 week post-op with shortness of breath. The most likely diagnosis is: 1) ST elevation MI 2) Digitalis toxicity 3) Pulmonary embolism 4) Ventricular tachycardia. Findings. Accelerated junctional rhythm Right axis deviation

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ECG Review

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  1. ECG Review James T. DeVries, MD 6 December 2004

  2. 45 yo female 1 week post-op with shortness of breath The most likely diagnosis is: 1) ST elevation MI 2) Digitalis toxicity 3) Pulmonary embolism 4) Ventricular tachycardia

  3. Findings • Accelerated junctional rhythm • Right axis deviation • “S1Q3T3” pattern • Clinical history and EKG most consistent with acute PE

  4. 67 yo dialysis patient without symptoms The most likely diagnosis is: 1) Pacemaker malfunction 2) Hyperkalemia 3) Normal EKG for dialysis patient 4) Intermittent LBBB

  5. Findings • NSR with 1rst degree AVB • injury current V1-V2 • Peaked t waves • Leftward axis • Findings most c/w hyperkalemia

  6. 49 yo male with chest pain This EKG demonstrates 1) acute anterior infarction 2) acute inferior/posterior injury without RV involvement 3) acute inferior/posterior injury with RV involvement 4) acute pericarditis

  7. Findings • Sinus brady • inferior STEMI • posterior STEMI • V1 ST elevation • Most consistent with inferior/posterior STEMI with RV involvement

  8. 77 yo woman with hypertension • This EKG demonstrates • atrial flutter with 3:1 conduction • 2) left ventricular hypertrophy • 3) no abnormalities • 4) left anterior fascicular block

  9. Findings • NSR with 1°AVB • LVH • Best answer is LVH

  10. Sokolow-Lyon Sv1+Rv5/v6>3.5mm RI+SIII>2.5mm Ravl>11mm Cornell Sv3+Ravl >2.8 (men) >2.0 (women) Romhilt-Estes LV strain 3 LAE 3 LAD 2 QRS duration 1 R v5/v6>3 3 Sv1/v2>3 3 Largest R or S>2 3 5 or more points suggests LVH Criteria for LVH

  11. 54 yo female with lung disease and shortness of breath • The rhythm in this EKG is: • Ectopic atrial rhythm • NSR • Atrial bigeminy • Atrial flutter with block

  12. Findings • Ectopic rhythm • Note PR>110ms • Inverted p waves • Best answer: Ectopic atrial rhythm

  13. 22 yo male with lightheadedness and palpitation • In addition to an echocardiogram, this patient will likely require: • A permanent pacemaker • A heart transplantation • A coronary angiogram • An ICD

  14. Findings • NSR with PAC’s • LVH with repole • Hypertrophic cardiomyopathy- altered myocyte shape, size, and alignment, leading to LVH, diastolic dysfunction, and syncope/sudden death. Frequently require prophylactic ICD placement when identified.

  15. 57 yo female with exercise-induced palpitations This patient presents to your ER with a BP of 100/60. She recently had a normal coronary angiogram and echo. The most likely diagnosis is: 1) Aberrant SVT 2) VT 3) Sinus tach with LBBB 4) Artifact

  16. Findings • A/V dissociation • LBBB • Rightward axis • Positive QRS axis inferiorly • RV outflow tract ventricular tachycardia: typically catacholamine induced (post-exercise), have characteristic LBBB morphology with rightward axis and positive QRS vector inferiorly.

  17. 25 yo male with systolic murmur The most likely diagnosis is: 1) Congenital bicuspid aortic valve 2) Severe mitral stenosis 3) Pulmonic stenosis 4) Ebstein’s anomaly

  18. Findings • RVH • Rightward axis • The constellation of right ventricular enlargement with rightward axis in a young patient with a systolic murmur is most suggestive of pulmonic stenosis.

  19. Right axis deviation RVH COPD Lateral MI LPFB Secundum ASD RVH R>7mm in V1 or R>10 with RBBB Right axis S<2 in V1 qR pattern in V1 Quick Review

  20. 32 yo male with palpitations This ECG demonstrates: 1) Wandering atrial pacemaker 2) Junctional rhythm 3) Delta waves 4) Subtle Epsilon waves

  21. Findings • NSR with short PR • Delta waves • WPW

  22. 45 yo male with palpitations • The LEAST likely rhythm is: • AVNRT • Atrial flutter with 2:1 • Multifocal atrial tachycardia • Orthodromic atrioventicular tachycardia

  23. Findings • Narrow complex, regular tachycardia • No visible p waves • Multifocal atrial tachycardia requires >3 p wave morphologies and is slightly irregular

  24. The End

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